Criminal offending in mentally ill populations

There are currently more individuals diagnosed with severe mental illness (SMI) in jails and prisons in the United States than in hospitals [1]. Deinstitutionalization (explained in the next paragraph), changes in sentencing policy, the war against drugs and mass incarceration have all contributed to the dramatic increase in the number of mentally ill who are incarcerated [2]. Severe mental illnesses such as schizophrenia, bipolar disorder, major depressive disorder and borderline personality disorder affect one in five adults at some point in their lives [3]. Of those, approximately three in ten people have interactions with the criminal justice system [4] resulting in one million SMI individuals detained per year [5].

Deinstitutionalization began in 1955, it is the process of replacing long-stay psychiatric hospitals with mental health services for individuals diagnosed with a mental disorder or developmental disability. As a result, individuals were forced to use private mental health services to get treatment. However, not everyone had access to private insurance, and after being forced out of hospitals, with limited access to treatment, many previous patients were forced to live on the street or ended up in jail or prison.

Main hall of Kilmainham Gaol, a former prison in Dublin, Ireland (CC0 Creative Commons)

For the past seven years, I have been working with researchers in psychology and criminal justice to learn more about individuals with mental illness and their involvement in the criminal justice system. Now, I am working on my Ph.D. in the Department of Criminal Justice at Indiana University. My current research is focused on answering one primary question: How does the criminal justice system intersect with treatment pathways of SMI offenders? We know many people with SMI are involved in the criminal justice system at some point in their lives, but we do not yet know how or when the criminal justice system intersects with treatment pathways. There are five possible ways treatment pathways can be intersected by criminal justice (CJ) involvement:

I am very interested in why offenders take different pathways. For instance, individuals could be on different pathways if their symptoms of mental illness went unnoticed, or if they did not have access to finances or insurance in order to receive adequate mental health treatment. It has long been thought that individuals with mental illness that were involved in the criminal justice system might fare far worse later in life, meaning that they would be more likely to cycle in and out of the criminal justice system for years after their first interaction [6].

This research could answer questions such as: How are mentally ill offenders gaining access to treatment? How long does it take for them to receive treatment? Is the criminal justice system referring many offenders to mental health treatment facilities? Do different pathways have different long-term effects on criminal behavior? The findings from this research could be used to identify, intervene, and prevent other individuals in similar situations from becoming involved in the criminal justice system. Further, this information could help collaborative efforts between criminal justice and mental health agencies. Finally, if the criminal justice system is acting as a primary referral source for offenders with SMI, evidence of this will show the importance of crisis intervention training for professionals to better identify mental health symptoms in offenders.